How we breathe is something we rarely think about, but done correctly it can make a big difference in bladder emptying. So if you’re making lots of trips to the bathroom or have to sit back down a second time to make sure you’re truly empty, there is help for this problem. Learn the key points of diaphragmatic breathing so you can relax your pelvic floor muscles and empty your bladder effectively the first time!
Everyday the average person takes about 20,000 breaths. Most of these breaths are subconscious and require very little effort or thought about how we breathe. While breathing is mostly automatic, this system is complex and interacts with other organ systems of the body.
Inhalation happens as air flows inward, through our nose, down to our expanding lungs, while the ribs of our chest rise and our nostrils flare outward. Exhalation is the opposite, it is a gentle passive flow of air that leaves our body as the lungs empty and the chest lowers down. This flow happens with the help of our diaphragm muscle.
The diaphragm is a thin broad muscle that sits under our ribs, and moves with each breath regulating pressure within our abdomen and pelvis. This gentle pressure helps the lungs to inflate, gives oxygen to our blood, and ultimately provides nourishment to our cells. This movement of our breathing diaphragm also influences our pelvic floor muscles.
How are the muscles of the pelvic floor involved?
Like the diaphragm, the pelvic floor muscles stretch across our body from the pubic bone in the front of the pelvis to the tailbone in the back. These muscles are shaped like a hammock and provide support for our pelvic organs.
The pelvic floor muscles move with each movement of our breathing diaphragm. This movement is like a sail, moving downward with the pressure of our inhalation and upward with the exhalation. Our pelvic floor muscles move in the same directions as the breathing diaphragm with every breath.
When we inhale the pelvic floor muscles lengthen and relax, and with the exhale the pelvic floor muscles contract and lift upward. This gentle interplay of our breath, breathing diaphragm and pelvic floor muscles happens throughout our day and barely gets our attention until we have trouble with our bladder.
Why would the bladder have trouble emptying?
As a Pelvic Health Physical Therapist I see many women who have difficulties with bladder emptying and this can be due to several factors. It can develop after a woman gives birth to a child, changes in pelvic organ position (prolapse), the loss of hormones associated with perimenopause or menopause.
Difficulties can also arise due to poor habits adopted as a child, cultural factors and concerns about cleanliness. There can also be neurological factors such as a lack of sensation and muscle coordination problems that can affect how we empty our bladder.
In any event, having good toileting habits and being able to relax our pelvic floor muscles is key to being able to empty your bladder effectively. In order to do this without straining, pushing, or holding our breath, you need to be able to relax your pelvic floor muscles. And being able to do a deep belly breath or diaphragmatic breath is crucial to getting your pelvic floor muscles to relax or let go.
So what is diaphragmatic breathing?
Diaphragmatic breathing is an intentional way of breathing that emphasizes expansion of the abdomen at the level of the belly button with each inhale breath. When we breathe from our belly, the muscles of the abdomen relax, lengthen and protrude outward. This in turn allows the pelvic floor muscles to fully relax.
Our ribs are important for belly breathing as well. Think of your rib cage like an umbrella. When you breathe in, your ribs open up, expanding outward and your chest will lift slightly. As the air leaves your body, your ribs will return down to their resting position and the chest will drop. It’s very important to remember that our ribs circle our entire chest, so making sure you are breathing into the sides and back of the chest is important to get all parts of your umbrella.
Let’s give it a try!
Start by sitting in a comfortable chair with good back support. Make sure both feet are flat on the ground and your hips relaxed and (ideally) slightly higher than your knees.
- Close your eyes, or make them soft by keeping them open half-way.
- Place one hand in the middle of your upper chest over your sternum and the other over your belly button. Either hand is fine, so long as your arms are comfortable by your side.
- Take a deep inhale breath through your nose, and let the air out through barely open lips. Keeping your lips barely open or ‘pursed’ means that the air will be slower to leave your body, as opposed to having an open mouth.
- As you inhale, gently direct your breath towards your belly button. Actively allow the abdominal muscles to relax and lengthen as if you are inflating a beach ball. This gentle inflation should reach from your belly button to your pubic bone. Try to avoid pushing outward, which involves breath holding.
- Focus your mind on the flow of your breath into and out of the nostrils. Sometimes flaring the nostrils with the inhale can help to keep your mind focused.
- With each repetition focus on making that beach ball a little larger, and moving the ribs open a little wider.
- Repeat the above sequence ten to fifteen times, without rushing.
Kindness counts when learning something new!
Be kind to yourself as you are learning this new skill. I find that many women (and men) have difficulty with belly breathing because we have been taught to constantly hold our abdominal muscles in to look better. And because this is such a different way of breathing it may take awhile for the muscles to fully relax.
Our body develops muscle memory with repetition of any new action or skill. Kindly working with ourselves without judgement is key to making this a habit we adopt for life. Mentally adopting positive mantras can help. As a Pelvic Physical Therapist I always share with my clients the following mantra;
Practice not Perfection is my Journey
Which means that in any practice, showing up and trying our best is key to creating positive associations with any new skill. While holding onto expectations of perfection often lead to frustration, negativity and self-doubt.
Bonus! diaphragmatic breathing is also calming.
If diaphragmatic breathing feels familiar to you, that’s probably because it is. This type of breathing is similar to some forms of yogic breathing, meditation or breath work you might find for singing or vocal training. And if you’ve noticed a calming effect on your whole body, there is a good reason for that insight.
Diaphragmatic breathing also activates our parasympathetic nervous system (think the opposite of fight-or-flight) which brings a sense of calm to our brain. Because of this, it is also used by mental health professionals for the management of anxiety and stress. So not only does belly breathing help with our bladder, but it also has many helpful effects on our mind, body and state of being. Yay!
What is your experience with Diaphragmatic Breathing?
Leave a comment and let me know. 
Tami Lines is a licensed Physical Therapist with certifications in Pelvic Rehabilitation and Women’s Health Coaching. She is the founder of Pelvic-Health-Matters. Tami has over 15 years of experience with expertise in bladder Health, and pelvic floor muscle dysfunction for adolescent and adult women. She is also a mom of two wonderful young adults working their way through college.
